
First Name
Kenny Stracke
Last Name
Doe
Date of Birth
2000-09-12
Gender
Other
Phone Number
(894) 404-5168
Insurance Provider
Koss, Douglas and Hudson
Patient ID
2141
Emergency Contact
Jane Doe (+1 987 654 3210)
Street Address
123 Main St, Apt 4B
City
Denver
State/Province
Colorado
Zip Code
80202
Country
United States
Emergency Contact Address
456 Elm St, Apt 10C, Denver, CO